Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 3734-012 | WI |
NPI | 1003916610 |
---|---|
Provider Name | Ryan T Vanroo |
First Address | Janesville, WI 53545-0441 |
Second Address | Janesville, WI 53545-0441 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2006 |
Last Update Date | 09/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
38929900 | (05) | WI |
38994700 | MEDICAID GROUP (01) | WI |
U83425 | (02) |